Two shortened treatment regimens found to be safe, effective for COVID-19

COVID-19 vaccination card
COVID-19 vaccination card

The Union World Conference on Lung Health 2022 (WCOLH) opened today by announcing results from the world’s largest clinical trial for MDR-TB treatment, sharing the experiences of scientists and TB survivors in Ukraine and preparing ourselves for the next pandemic.

The event takes place against the backdrop of increasing TB cases and deaths, conflict around the world and with much still to be done to tackle the COVID-19 pandemic.

Guy Marks, President of The Union and convenor of the WCOLH, said: “Many people in the developed world regard tuberculosis as a historical disease and one that has passed. In fact, that is far from the truth. Prior to COVID, tuberculosis killed more people than any other infectious disease in the world and still kills 1.5 million people a year, and there are 10 million cases every year.

“In the most recent data there has been an increase, both in the incidence and number of people dying due to tuberculosis. What this means is that there is real urgency about trying to turn around this epidemic.”

Research fills important gap in evidence on shortened regimens for MDR-TB
In the opening press conference today, the STREAM trial team announced results from their study of two new bedaquiline-containing shortened treatment regimens for MDR-TB. The results show both a fully-oral 9-month regimen and a 6-month injection-containing regimen to be safe and effective, and also result in lower costs to patients.

Globally, there were an estimated 450,000 incident cases of MDR-TB or rifampicin-resistant TB in 2021, up 3.1% from 437,000 in 2020.

“These results are very encouraging for the thousands of people affected by MDR-TB. Increased effective treatment options, means better choices for people with TB, which ultimately improves treatment outcomes and quality of life,” said Guy Marks, President of The Union, convenor of the World Conference.

“In STREAM Stage 2 we generated robust scientific evidence regarding the safety, efficacy, and cost-effectiveness of two shortened regimens for MDR-TB, providing guideline development groups and national TB programs with better information to underpin their decisions about the most appropriate treatments for their populations,” said I.D. Rusen, Senior Vice President, Vital Strategies, and Sponsor for the STREAM trial.

The impact of the Ukraine war on essential TB care

Olya Klymenko, a TB survivor, spoke of the reality facing thousands of vulnerable people trying to access TB care and treatment in Ukraine. “For the world to start acting, it needs to be pushed. One such push was the COVID-19 pandemic, now it is the war.

“The world will never be the same, but even in this new world people still die of TB.

“I fight for the future of our children without TB, without wars, in a world where the human right to life and health are not empty words, but a cause for action.

“We all understand that we need prevention programmes and improved access to treatment for all countries. In Ukraine our hospitals were bombed. How do we treat the millions of sick people then?

“We need to change our thinking and be committed to providing health services, even though the hospitals may not be there. Let us build a robust system of services together. As we have seen that if we are united and coordinated there is nothing impossible for us.”

Natasha Deyanova, Research Manager at the Organization for Appropriate Technologies in Health, shared harrowing stories from the frontline: “These people, these doctors courage and commitment are to be admired, because they kept doing their job for many weeks after the war began, with missile attacks, power outages and transport collapse. But what I admire most is the empathy they preserved.”

Natasha explained how her analysis of using digital technology to monitor tuberculosis treatment adherence became a ‘heart monitor’, because when the people opened their medicine boxes the doctors would know that they were alive.

Lessons learned from COVID preparedness and what we need to do for the next pandemic

Raina MacIntrye, Professor and Head of Biosecurity Program within the Kirby Institute at University of New South Wales, shed light on some of the lessons not yet well appreciated including the reasons why wealth does not guarantee success, the role of disinformation in digital age and the way that culture and leadership define pandemic response.

“There were lots of lessons, including culture, leadership, universal health care, global equity. But at the same time wealth doesn’t guarantee success. We saw low-income countries, like Samoa and Vietnam, do very well in the first year of the pandemic, and we saw high-income countries do poorly.

“99% of investment is in acute medicine and very a tiny fraction of the investment is in public health and prevention. So too is the investment in pandemic preparedness, largely around drugs, vaccines, and diagnostics, but things like rapid epidemic intelligence or early warning systems can prevent a pandemic if you pick it up before it spreads. If there had been a system that had picked up COVID before it spread out of China, the whole pandemic could have been prevented.”

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